Adrienne W. Email & Phone Number

Appleton, Wisconsin, United States

• Responsible for supporting our Account Management team in resolving Medicare Part D-specific client issues.• Responsible for EGWP operational performance management.• Provides support for annual plan submission of our EGWP plans to the Centers for Medicare & Medicaid Services (CMS), including proficiency in using CMS plan benefit package software.• Responsible for creating and maintaining Medicare benefit specification documents for all EGWP client implementations and re-implementations. • Develops and maintains templates, including Spanish-translated versions, for the annual Medicare Part D Prescription Drug Plan Employer Group Waiver Plan (EGWP) beneficiary materials. Using these templates, the SPM is responsible for developing, reviewing, and quality control all annual EGWP client member materials. Ensures documents are compliant with CMS regulations.• Provides oversight for managing translations and web posting of annual Medicare Member materials.• Provides Medicare Part D EGWP support and guidance for the annual EGWP client implementation and re-implementation teams.• Provides guidance and training to our Account Management teams on Medicare Part D EGWP topics.• Develops and maintains subject matter expertise related to all Medicare Part D regulations applicable to EGWP products. • Evaluates group Medicare Part D existing products and competitor and industry data to improve existing products and recommend new products.• Provides operational support for various processes, including fulfillment of ad hoc member material requests and general member materials support.• Led various projects focused on enhancements to our Medicare Part D EGWP product offering.

Assisted in Medicare plan finder file creation, quality assurance and data submission following the Centers for Medicare and Medicaid Services regulated schedule. Performed initiatives to improve Star Ratings in the Medicare marketplace that impact the company's growth and financial objectives. Impacted the health care system through the analysis and interpretation of data and presenting recommendations for business solutions.• Implemented UnitedHealthcare’s Medicare Part D contracts plan finder functionality to be accessible on www.medicare.gov.• Resolved CMS outliers to prevent plan finder suppression.• Created and analyzed Price Accuracy Index reports to forecast and improve Star Ratings in the Medicare marketplace.• Led automation projects that improved business processes.

Researched, gathered, analyzed complex operational and customer data in order to identify trends, create forecasts and present multifaceted information to executive decision makers. Instrumental in providing data for strategic business planning process, initiatives integration and achieving both long and short-term objectives for Employer Group Waiter Plan clients. Identified innovative solutions, migrated information, trained staff and exceeded performance goals.• Pinpointed redundancies and non-performing areas in order to create strategic plans to deliver positive outcomes in a demanding setting.• Created job material and a SharePoint site to educate cross-functional leadership teams that provided the foundation to identify opportunities and boost client participation.• Served as client account liaison for Employer Group Waiver Plan contract, researched contract requirements, anticipated issues and integrated solutions to achieve quality standard measurements.• Led an online forum with over 100 participants.

Tulsa, Oklahoma Area

• Coordinates quality review of pharmacy processes, and makes recommendations for corrective actions• Act as a Liaison between GlobalHealth pharmacy staff and PBMs, and provides project management and oversight for interactions with PBM• Prepares and supports the submission of regulatory agency applications, reports, or correspondence related to the pharmacy benefit.• Reviews all regulatory agency submission materials related to the administration of the pharmacy benefit to ensure timeliness, accuracy, comprehensiveness, or compliance with regulatory standards.• Provides regulatory guidance to departments or development projects regarding design, development, evaluation, or marketing of plan related to the pharmacy benefit.• Formulates & implements regulatory affairs policies and procedures to ensure that regulatory compliance is maintained or enhanced in relation to the pharmacy benefit.• Communicates regulatory information to multiple departments and ensures that information is interpreted correctly.• Manages preparedness activities related to pharmacy benefit for audits and regulatory agency reviews.

Tulsa, Oklahoma Area

• Provides reporting and data analysis to the pharmacy department and plan senior executive. • Presents actionable data and analysis to support senior executive staff decisions on benefit design, utilization management, and government reporting requirements. • Supports many internal plan committees by providing data and analysis for review and oversight by committee members. • Develops, updates, and maintains the department’s commercial prior authorization forms and prescription claims databases for all lines of business, UM departments, HRA, and Member Outreach.

Responsible for the due diligence of the collection of problem loans and relationships, and provides support to the Special Assets team with the goal of reducing losses and maximizing recoveries.• Ensures collateral position through independent research respective to UCC filings, title searches, insurance verification, etc.; and uses judgment to determine appropriate course of action to solve for any deficiencies in findings.• Responsible for identifying collateral and beginning applicable processes to protect collateral to prevent future loss• Analyzes loan agreements to find possible solutions embedded in the documents then uses judgement to determine appropriate course of action for any deficiencies in findings• Works with customers, vendors, department staff and bank management regarding inquires on transactions, account status and operations. Responsible for accurate resolutions of routine account problems.

Perform a wide range of banking operations requiring a broad knowledge of banking practices, regulatory requirements and daily procedures essential to retaining and expanding relationships with financial customers and building a deposit base. Cross-trained for all positions in the operations department.• Balance ACH, Wire Transfer, non-posts, charge backs and special items in order to balance transactions with the Federal Reserve• Process investment transactions with Dreyfus and Fidelity • Process Tax Garnishments, IRS/State/Court Levies in accordance with banking polices and laws• Monitor accounts for Identity Theft, OFAC, & Red Flags; confirm accuracy of transactions• Consistently meet/exceed expectations; recognized for outstanding service abilities • Reports charge off accounts and recoveries to ChexSystems & Tulsa Adjustment Bureau • Set up business clients to business banking website using access manager program• Set up, maintain, & audit certificate of deposits & Individual Retirement Plans according to proper guidelines. Input current rates of accounts.

Bachelor Of Science In Business Administration, Pharmaceutical Marketing And Healthcare Management

Graduated with a Bachelor of Science in Business Administration of Sciences .The focus of the degree was in Health Care Administration.

Bachelor Of Business Administration (B.B.A.), Nursing Concentration

Entrepreneurship/Entrepreneurial Studies

The Oklahoma State University Cowboy Bootcamp for Entrepreneurs was a hands-on learning experience for eager minds wanting to start.